Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Apr 3:20:82.
doi: 10.1186/s13054-016-1257-x.

Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial

Michael W Donnino  1   2 , Lars W Andersen  3   4   5 , Katherine M Berg  6 , Maureen Chase  3 , Robert Sherwin  7 , Howard Smithline  8 , Erin Carney  3   9 , Long Ngo  10 , Parth V Patel  3 , Xiaowen Liu  3 , Donald Cutlip  11 , Peter Zimetbaum  11 , Michael N Cocchi  3   12 ; Collaborating Authors from the Beth Israel Deaconess Medical Center’s Center for Resuscitation Science Research Group
Collaborators, Affiliations
Randomized Controlled Trial

Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial

Michael W Donnino et al. Crit Care. .

Abstract

Background: The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock.

Methods: We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a minimum of 1 hour. Patients were randomized to intravenous hydrocortisone 100 mg or placebo every 8 hours for 7 days or until shock reversal. The primary endpoint was time to shock reversal.

Results: Fifty patients were included with 25 in each group. There was no difference in time to shock reversal between groups (hazard ratio: 0.83 [95% CI: 0.40-1.75], p = 0.63). We found no difference in secondary outcomes including shock reversal (52% vs. 60%, p = 0.57), good neurological outcome (24% vs. 32%, p = 0.53) or survival to discharge (28% vs. 36%, p = 0.54) between the hydrocortisone and placebo groups. Of the patients with a baseline cortisol < 15 ug/dL, 100% (6/6) in the hydrocortisone group achieved shock reversal compared to 33% (1/3) in the placebo group (p = 0.08). All patients in the placebo group died (100%; 3/3) whereas 50% (3/6) died in the hydrocortisone group (p = 0.43).

Conclusions: In a population of cardiac arrest patients with vasopressor-dependent shock, treatment with hydrocortisone did not improve time to shock reversal, rate of shock reversal, or clinical outcomes when compared to placebo.

Clinical trial registration: Clinicaltrials.gov: NCT00676585, registration date: May 9, 2008.

Keywords: Adrenal; Cardiac arrest; Hydrocortisone; Shock; Steroids; Vasopressors.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Cytokine levels at 24 hours. Log-transformed interleukin (IL)-6 (left) and IL-10 (right) levels 24 hours after study drug administration. There was significantly lower IL-6 levels at 24 hours in the hydrocortisone group compared to the placebo group (p = 0.008) but no difference in IL-10 levels (p = 0.22). The dots indicate the means and the error bars the standard deviation
See this image and copyright information in PMC

Comment in

References

    1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–292. doi: 10.1161/01.cir.0000441139.02102.80. - DOI - PMC - PubMed
    1. Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S640–56. doi: 10.1161/CIRCULATIONAHA.110.970889. - DOI - PubMed
    1. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010;81(10):1219–76. doi: 10.1016/j.resuscitation.2010.08.021. - DOI - PubMed
    1. International Liaison Committee on Resuscitation 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation. 2005;67(2-3):213–47. doi: 10.1016/j.resuscitation.2005.09.018. - DOI - PubMed
    1. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S768–86. doi: 10.1161/CIRCULATIONAHA.110.971002. - DOI - PubMed

Publication types

MeSH terms

Associated data